title: Postoperative bleeding risk for cutaneous surgery in the head and neck region with continued phenprocoumon therapy.
abstract: In a total of 171 surgical procedures for lesions in the head and neck region in patients in whom phenprocoumon therapy was not stopped, 16 (9%) postoperative bleeding events were observed over a follow-up period of two weeks. Local measures were sufficient in all cases except one severe case where blood transfusion was needed and anticoagulant treatment was stopped for 7 days. The bleeding risk was significantly higher for the surgical procedures of the nose than those in other areas (21% versus 6%, P = 0.014), but was not influenced by the international normalized ratio (INR) of blood coagulation, size, site and type of the lesion, surgical procedure, and sex and age of the patients. The bleeding rate in patients not on any anticoagulation therapy was significantly lower (6/211 = 3%). Across both groups, just over 80% of the bleeding episodes were within the first two days (55% on the same day and 32% on the next day) of the surgery. No bleeding was recorded after 5 days. Our data suggest that cutaneous surgery in the head and neck region can be safely performed with continued phenprocoumon therapy in most cases in an INR range of 1.3-3.4, but rarely severe bleeding does occur and can be managed with a close-contact follow-up and with 24-h on call services during the first two days postoperatively.
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Max Heiland), University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany; Department of Oral and Maxillofacial Surgery (Head: PD Dr. Dr. Wolfgang Eichhorn), General Hospital Balingen, Balingen, Germany.
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Eichhorn
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Max Heiland), University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany.
authors.forename: Evgeny
authors.initials: E
authors.lastname: Barsukov
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Max Heiland), University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Al-Dam
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Max Heiland), University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Gröbe
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Max Heiland), University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany.
authors.forename: Ralf
authors.initials: R
authors.lastname: Smeets
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: PD Dr. Dr. Wolfgang Eichhorn), General Hospital Balingen, Balingen, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Eichhorn
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Max Heiland), University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany. Electronic address: m.heiland@uke.de.
authors.forename: Max
authors.initials: M
authors.lastname: Heiland
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Max Heiland), University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany; Department of Neurology (Head: Prof. Dr. Christian Gerloff), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Lan
authors.initials: L
authors.lastname: Kluwe
authors.affiliation: Department of Oral and Maxillofacial Surgery (Head: Prof. Dr. Max Heiland), University Medical Center Hamburg-Eppendorf, Martinistr. 52, Hamburg 20246, Germany.
authors.forename: Marco
authors.initials: M
authors.lastname: Blessmann
mesh_terms: D000359:Aftercare; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000556:Ambulatory Surgical Procedures / Q000379:methods; D000925:Anticoagulants / Q000627:therapeutic use*; D001458:Bandages; D001803:Blood Transfusion; D062109:Dermatologic Surgical Procedures / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000601:surgery*; D006406:Hematoma / Q000209:etiology; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D019934:International Normalized Ratio; D008297:Male; D015580:Mohs Surgery / Q000379:methods; D009666:Nose / Q000601:surgery; D010644:Phenprocoumon / Q000627:therapeutic use*; D019106:Postoperative Hemorrhage / Q000209:etiology*; D019651:Plastic Surgery Procedures / Q000379:methods; D018570:Risk Assessment; D013524:Surgical Flaps / Q000601:surgery
chemical_list: D000925:Anticoagulants; D010644:Phenprocoumon
keywords: Anticoagulation therapy; Bleeding; Cutaneous surgery; Head and neck surgery; Phenprocoumon